Bite magazine August 2010

Bite magazine is a business and current affairs magazine for the dental industry. Content is of interest to dentists, hygienists, assistants, practice managers and anyone with an interest in the dental health industry.

Bite
ISSUE 58, AUGUST 2010, $5.95
INC. GST
BETTER BUSINESS FOR DENTISTS
An empire
of one
How Dr Harry Margets found
that size isn’t the only secret
to success
Something fishy
Who needs a wall in
your surgery when you
can have an aquarium?
Beating the
bullies
How to tackle
workplace bullying in
your practice, page 28
Fairy tales
The true story of
how one oral health
therapist turned into a
fairy, page 12
The turn of
the screw
The tricky choice
between endodontics
and implants, page 25
The reviews are in!
Why performance
evaluations are
necessary in your
practice
Passions
Dr Julian Leigh’s
burning passion
!
IN
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TA-98 C LED
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Bur length up to 25 mm
TA-97 C LED
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Pegasus Dental Services Pty Ltd (02) 9584Maintenance
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East Coast Dental Services Pty Ltd 0418 790 585
Medi-Dent Pty Ltd 1300 886 674
Ross Jones Dental (07) 3391 0208
Suntech Dental Equipment Services (07) 5351 1336
For more information Email: a-dec@a-dec.com.au
Phone: 1800 225 010
Visit: www.wh.com
VIC
Alldent Pty Ltd (03) 9646 3939
Medi-Dent Pty Ltd 1300 886 674
SA/NT Dental Concepts (08) 8293 4144
WA
West Coast Dental Depot (08) 9479 3244
Contents
Issue 58 / August 2010
Features
16
PHOTO G RA P HY: EA MO N G A LLA G H ER
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This month
IN
W
03
Cover story
Your world
Wild about Harry
Stephanie Wilson has
combined entrepreneurial
flair and fairy wings to
create a clinic kids love
coming to
12. Fairy Lights
The East Bentleigh
Dental Group is a case
study in how to build
up a large successful
practice by staying true
to your vision
Your business
12
20. Underwater love
When patients see
calming vision of fish
rolling through coral
during their surgery at
Dental Lounge, it’s not the
painkillers kicking in
25. The turn of
the screw
Editorial Director
Rob Johnson
Sub-editor
Lucy Robertson
Contributors
Sharon Aris, Nicole Azzopardi,
Kerryn Ramsey, Lucy Robertson,
Maureen Shelley, Gary Smith
05
Commercial Director
Mark Brown
For all editorial or
advertising
enquiries:
Phone (02) 9660 6995
Fax (02) 9518 5600
Suite 4.08, The Cooperage
56 Bowman Street
Pyrmont NSW 2009
7,616 - CAB Audited as at
March 2010
Bite magazine is published 11
times a year by Engage Media,
ABN 50 115 977 421. Views
expressed in Bite magazine are not
necessarily those of the publisher,
editor or Engage Media.
Printing by Superﬁne Printing.
When are implants the
right decision? It’s a
tricky question for any
practitioner and some
experts think not everyone
is qualified to answer it
28. Beating the bullies
Workplace bullying
happens more frequently
than you may think.
Creative Director
Tim Donnellan
20
25
30. Good reviews
06
News &
events
05. Promising nothing
At least the Greens have
released a dental policy, while
the others flounder
and dissemble. ALSO
THIS MONTH: the ADA
says to major parties, ‘we’re
watching’; Dental Corp
goes international; a country
practice does better than
anyone thought; and much,
much more …
If Performance Evaluation
sessions are the time of
year that everyone dreads,
then it may be time to
reconsider the way you
are doing business
Your tools
35. Tools of the trade
A great intraoral
camera, an excellent
intraligamentary syringe,
and a good pair of ears
and more are all on show
this month
35
Your life
38. Passions
Dr Julian Leigh, of Half
Moon Dental Centre, has
a burning passion
38
Bite 3
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05
News bites
Promising nothing
A new campaign has been launched by a coalition of health organisations calling for
election committments to better dental care.
A
coalition of national community, dental and health
organisations have launched
a national campaign, Stop
the Rot, calling on political leaders to
make an election commitment for urgent
action to address the decaying state of
Australia’s dental care system.
In a statement released at the end of
July, the National Oral Health Alliance
calls for more affordable and timely dental
services, particularly for low-income
Australians who are mostly likely to suffer
from poor oral health.
More than seven million Australians
can’t access dental care when they need
it because of long waiting lists and one in
three people put off having dental treatment because they can’t afford it.
“The health and social impact of poor
oral health is immense,” the Alliance says
in its statement.
“For people with serious oral health
problems, nine out of ten experience pain
or discomfort and the same proportion
have experienced embarrassment due
to their teeth, contributing to poor self
image, reducing their social interactions
and limiting employment prospects. It is
vital to improve accessibility so that all
Australians have equitable access to oral
health care.
The alliance call comes after Labor
failed to introduce a Commonwealth
Dental Health Program (CDHP) in their
last term of government because of
the Senate’s refusal to axe the costly
Medicare dental program introduced by
the previous government. Labor says
it will push ahead with the scheme if it
is returned to power. It has rejected a
recommendation by the National Health
and Hospitals Reform Commission to
establish a universal ‘’Denticare’’ scheme.
The Australian Greens leader Bob
Brown has announced the Greens
will push for universal dental care and
increased funding for dental health
would help about 500,000 Australians,
ADA hits the
hustings
As major parties avoid the issue, Greens
leader Bob Brown has announced a
dental policy.
languishing on waiting lists, get the treatment they needed. He estimated the
proposal would cost around $4.3 billion,
but produce savings to overall health
costs of $2.3 billion.
“Good teeth are fundamental to good
health,” Senator Brown said when releasing the policy at the end of July.
“Poor dental health can affect people’s
overall health, ability to ﬁnd employment
and general well-being.” £
The ADA has requested that the
major political parties respond
to a list of questions on dental
care programs. Reponses (or lack
thereof) will then be compiled into
an ADA Federal Election 2010 Report Card which will be accessible
from the ADA website.
“The key component of any
Australian oral health solution is
to focus attention on those within
the community that have difﬁculty
accessing dental care. The ADA’s
strong recommendation to all
parties is to introduce a scheme
that will direct its immediate
attention to improve access to
dental services for Australia’s
disadvantaged, whether this be
ﬁnancial or geographic” Dr Neil
Hewson, President of the ADA said
in a news release.
A level of political stasis has
settled around the debate since
2007, when the then-Rudd government’s attempts to introduce
a Commonwealth Dental Health
Program was blocked by the
opposition and minor parties in
the Senate, when they refused to
allow the closure of the Medicare
EPC scheme. After a brief ﬂare-up
with the introduction of ‘Denticare’ by the National Health and
Hospitals Commission—which
was promptly ignored by the government—the Senate stand-off
continued. £
Bite 5
06
News from our partners
A-dec ﬁlls market niche
Innovative European dental equipment manufacturer, W&H has released its ultimate generation
dental turbine, the Synea LED+.
T
he new Synea
LED+ builds on the
advanced design of
the original Synea
LED, which was the to ﬁrst
introduce LED technology
into handpieces in 2007.
“The ‘ultimate’ is deﬁned
as the very best of its
type, and the Synea LED+
reﬁnes LED technology to a
new level. If you were only
going to buy one dental
turbine, this would be the
one to buy,” W&H Product
Manager, Shal Haﬁz, said.
“Among the
improvements to the
Synea LED+ model is an
enhancement to the LED
unit to produce the highest
Colour Rendering Index
available. This has particular
application in medical use.
“The clarity, intensity
and broad spread of light
provides optimal illumination
in deep cavities, helps
correctly diagnose tooth
structure and gum tissue
in its natural colour and is
bright enough to cut through
the water spray during
procedures.”
Mr Haﬁz explained that
the development of W&H’s
Synea turbines was all about
delivering innovation that
provided real beneﬁts to the
end-user.
“This began with the very
narrow, yet powerful Synea
Diamond
Perfect LED
positioning
W&H’s ultimate generation dental turbine, the Synea LED+.
‘hygienic’ head design
with penta-spray, providing
the best visibility and best
cooling and also prevents
backﬂow of liquid and air
into the turbine gears.
Two models are available,
the TA-97C LED with its
extremely compact head
suitable for everyday use
and the more powerful 20
Watt TA-98C LED for bur
lengths of up to 25 mm.
All the new Synea
models feature ceramic
bearings, providing quiet
operation and long life, while
withstanding the rigours of
daily thermo-disinfector and
sterilization cycles.
“In fact the reliability of
W&H turbines is legendary
and they are also among the
most comfortable and quiet
of handpieces. That’s hardly
surprising as W&H invented
the modern handpiece and
has never stopped reﬁning
it,” Mr Haﬁz said.
W&H Synea models
feature light overall weight
(with a choice of RotoQuick
Sapphire
Ruby
6 Bite
or Multiﬂex coupling), have
a comfortable ergonomic
design and grip pattern,
while the lower head height
provides the best view of the
bur and work area during
treatment.
Experien
“The LED light source is
located near the head of the
handpiece which provides
the brightest and broadest
illumination of the work area,
unlike the ‘spotlight’ effect
of other LED designs,” Mr
Haﬁz explained.
“Also, there are no
light transmission losses
associated with inferior
technologies including
halogen and other LED
turbines which employ glass
rods from a remote LED
light source in the coupling
or base of the instrument.
“All of these signiﬁcant
beneﬁts unique to the W&H
Synea LED+ add up to
the ultimate dental turbine,
enabling the user to work
more comfortably and
productively, by assisting
with diagnosis and treatment
through superior visibility and
ergonomics inherent in the
handpiece design.” The W&H
Synea LED+ range comes
with a two year warranty
and is available from A-dec
dealers around Australia. £
Quintessence
BOOKS
Hear all these Authors and more at the
2010
INTERNATIONAL
Don’t miss this rare opportunity
to hear these speakers and
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Quintessence Symposium in Sydney – 29-31 October
Color Atlas of Cone Beam Volumetric Imaging
for Dental Applications
Dale A. Miles
Now regarded as the standard of care for some applications in dentistry, cone beam volumetric imaging
(CBVI) is profoundly inﬂuencing clinical decision making like no other imaging modality developed
in the past century. Yet many practitioners remain uncertain about its range of applications, safety,
and cost, as well as how and when to integrate it into their clinical practice. This sleek, full-color atlas
addresses each of these topics in succinct fashion. The author, a practicing oral and maxillofacial
radiologist, introduces readers to all of the various ways of viewing CBVI data sets and guides clinicians
in identifying familiar anatomic landmarks in the three planes of section (axial, sagittal, and coronal).
Comprehensive case presentations demonstrate the diagnostic and treatment-planning capabilities of
CBVI in its full range of applications (eg, airway studies, implant site assessment, odontogenic lesion
visualization, 1:1 space analysis) while at the same time highlighting situations in which traditional
two-dimensional imaging will sufﬁce. A must-read for students and practitioners at all levels and in all
specialties of dentistry.
Q-5120600
$287
320 pp; 442 illustrations (mostly color)
Essentials in Piezosurgery:
Clinical Advantages in Dentistry
Tomaso Vercellotti
This book presents the clinical advantages of Piezosurgery over traditional methods for tooth
extraction, ridge expansion, sinus lifts, bone grafting, and clinical crown lengthening, as shown by
research and clinical experience over the decade since the author ﬁrst developed the technique.
The reader will also ﬁnd information about recent advancements in the ﬁeld, including a presurgical
assessment of implant site anatomy, based on a newly developed bone classiﬁcation, and an innovative
ultrasonic implant site preparation technique, which allows optimization of implant placement in
difﬁcult anatomic areas. In addition, the book describes the use of orthodontic microsurgery, a new
orthodontic-piezosurgical technique that allows rapid tooth movement while preventing damage to the
periodontal tissues. General practitioners, oral surgeons, and implant dentists will ﬁnd unique insight
into the clinical beneﬁts of piezoelectric bone surgery.
®
Q-5120627
$251.31
136 pp; 340 color illus
The Science and Art of Porcelain
Laminate Veneers
Galip Gurel
The Science and Art of Porcelain Laminate Veneers details the expanding ﬁeld of porcelain laminate
veneers in esthetic dentistry. It guides the esthetic dentist in understanding the needs of the patient and
formulating a treatment plan that includes not only esthetic considerations, such as color and smile
design, but also occlusal, periodontal, and functional requirements. In addition, it discusses the use
of porcelain laminate veneers in diastema closure, the treatment of tetracycline discoloration, and in
conjunction with orthodontic therapy. New techniques to ensure minimally invasive tooth preparation
and maximum space creation for the dental technician are explored, and impression materials for
porcelain laminate veneers are compared. The detailed guides to alternative porcelain materials and
their step-by-step applications make this book invaluable for general practitioners, dental technicians,
and the entire esthetic team.
Q-5120432
$378.35
528 pp; 1,200 color illus
For more information on the 2010 Quintessence Symposium please contact
Nareida Mitchell +61 2 9697 6288 or email nareida.mitchell@henryschein.com.au
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8 Bite
09
News bites
A country practice
Recommend the
STRONGEST
pain reliever
available without
a prescription.*
*Based on codeine content per dose
An award-winning dental
clinic in Brewarrina is looking for funding to remain
open for the next two years,
following its unexpected
success. The surgery
started early last year,
providing a local dental
service that had not been
available for years. It recruits
ﬁfth year university students
to help provide greater access to dentist services for
residents in the region.
The Brewarrina Shire
Council’s Economic Development Ofﬁcer, Belinda
Colless, says the practice
has hit all objectives set
for it: “We are just at the
moment reviewing what
we’ve done and getting a
clear direction on where we
are going to and obviously
seeking to have the project
refunded until 2011.”
Last month, the Brewarrina Shire Rural and Remote
Dental Project was selected
from 216 entries from councils across Australia and
announced as the winner
of the prestigious National
Local Government Award
for Excellence.
The win was a surprise
for the Brewarrina Shire
Council Mayor, Matthew
Slack-Smith, who after
accepting the award commented, “Not only does
Brewarrina have improved
health outcomes for the
community but this award
shows that even little towns
like Brewarrina can come
up with projects of signiﬁcant importance.”
Belinda Colless, from the
Brewarrina Shire Council
said the project is currently
meeting targets and is making a real different to oral
health in the community. £
Dental Corp goes
international
Last month Dental Corporation announced its expansion to New Zealand when
Centre of Dental Excellence, based in Wellington,
joined the group on 16 July.
Dr Ray Khouri, executive
director at Dental Corporation says, “We are delighted
to announce our plans to
partner with premium dental
practices across New Zealand. This strategy forms a
key element of our expansion plans for the business,
and positions us well to
continue the strong growth
we have delivered over the
past two and a half years.
We currently have 12 New
Zealand practices under
purchase agreements and
anticipate more than 20
New Zealand practices will
join the group by the end
of calendar 2010.” From
acquiring the ﬁrst Australian
practice in October 2007,
Dental Corporation is now
Australia’s largest provider
of dental services owning
112 practices with the addition of the ﬁrst practice in
New Zealand. Annualised
revenue for the business
now exceeds $220 million.
Executive chairman of
Dental Corporation, Mark
Evans said, “Based on the
success Dental Corporation has experienced in
Australia and the outstanding response to its
offering amongst dentists,
it was logical for Dental
Corporation to expand our
operations to include New
Zealand. Our partnership
approach has proved very
attractive to the larger
sized, premium dental
practices which are our
target market. £
Bite 9
10
News bites
Boardroom blitz
The Dental Board of Australia
has been busy this month,
with several announcements
being released over recent
weeks regarding continuing
professional development,
codes and guidelines and
registration standards.
But the ﬂood of information
has returned a tsunami of
enquiries which has overwhelmed the agency’s
capacity to respond.
The body overseeing the
various health practitioners
boards, the Australian Health
Practitioner Registration
Agency (AHPRA), announced
recently, “When registrants
renew in the ﬁrst year, they
will be asked to declare that
they intend to meet the pro
rata CPD requirements during
The Dental Board’s hit the ground running, but not smoothly.
their period of renewal.”
The DBA has also released
the approved versions of their
codes and guidelines relating to: mandatory notiﬁcations; CPD; dental records;
infection control; the code of
conduct and limited registration for teaching.
Understandably, AHPRA,
which provides administrative support for all the national
registration boards, says their
Enquiry Contact Centre is
currently experiencing a high
volume of calls. An online enquiry form is available through
their website, at www.ahpra.
gov.au. In a statement AHPRA
said, “There have some key
pressure points in the ﬁrst
weeks of the scheme. This
includes our capacity to respond effectively to the 3000
enquiries daily to AHPRA and
some IT teething issues (many
of these are related to moving
1.5 million practitioner records
from 85 sources into a single
integrated IT system). AHPRA
has identiﬁed the problems
and is putting solutions in
place. We regret that these issues have caused frustration.
Delays are not acceptable.
We are working intensively on
solutions and ask for patience
as these take effect.” £
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10 Bite
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82 Hughes Avenue, Ermington, NSW 2115. 1800 028 533. GLA0116/BTE
12
Your world
Tooth fairies
Article Rob Johnson
Photography Stockxpert
Fairy lights
Stephanie Wilson has combined entrepreneurial ﬂair and fairy wings
to create a clinic kids love coming to
ost dentists say they would do
pretty much anything to ensure
children look after their oral
health. But would you dress up
as a fairy? Stephanie Wilson
would. And after doing so in her
Brisbane practice for a number
of years, she’s expanding her
tooth fairy presence to the Gold
Coast, books and a clothing
range. Wilson, a trained oral health therapist, has been dressing up as the tooth fairy for twenty years—a practice she started
while working for Queensland’s school dental service. “I’d do
tooth fairy days for health promotion,” she says. “I’d dress up in
the dental van as the tooth fairy. I realised the kids were so much
more comfortable when I did it.”
When legislation was enacted in 2003 allowing therapists to
own a dental practice, Stephanie saw an opportunity to start a
business realising her vision of taking away children’s dental fears
before they develop. “Luckily we [she and her husband Grant]
were in a financial situation where we could buy and build, so
in November 2003 we found a location and built a three-chair
practice there in 2004,” she says.
“I always wanted to do this for the children—I started dressing up as the tooth fairy not for children to overcome their dental
fears, but so they never knew there was a fear of going to the
dentist. This is to get rid of that, and for them to have a pleasant
experience.”
She registered the TFI brand (for Tooth Fairy International), and
started offering “Tooth Fairy Fridays” at the Brisbane TFI practice
back in 2004, and they were sufficiently popular to expand the
12 Bite
idea to Saturdays as well. Last month she expanded her Tooth
Fairy concept to the Gold Coast, with the opening two weeks
ago of TFI’s new Labrador surgery.
“We’ve found a lot of dentists don’t particularly want to treat
children, and will refer them directly to a paediatric dentist,” she
says. “So I have been going around introducing myself to practices to tell them we’re all in this together, and treating children is
a challenging thing to do, so if it’s not something dentists enjoy,
please feel comfortable referring them to us. We have special
fairy decorations in our rooms, and we dress up as fairies to treat
them. Often when we’re finished we’ll take a photo of the child
with the fairies and put them up on Facebook, with the consent
of the parents, of course.”
Currently, TFI employs four tooth fairies—Wilson, Emina Mumi-
“We’ve found a lot of dentists
don’t particularly want to treat
children, and will refer them
directly to a paediatric dentist.”
Stephanie Wilson, Tooth Fairy International
novic, Georgia Campbell and Ingrid Seibert. The principal dentist
in the practice is Dr Rhett Shapcott.
Although things are humming along nicely now, Wilson says
she was quite surprised by some of the attitudes she encountered when she first set up shop a few years ago. “It was amazing for me,” she says. “When I would interview dentists and tell
them the philosophy of the practice, some would just stand back
and say ‘you’re not a dentist’. I said that it shouldn’t matter, but a
Stephanie Wilson (on the
right) with fellow tooth fairies
Georgia Campbell (left) and
Emina Muminovic (centre).
Bite 13
Your world Tooth fairies
Wilson has extended her tooth fairy concept to a book.
lot of dentists walked away. They just didn’t want to know. And it
just took one to come on board before it became acceptable.”
In a move guaranteed to elicit nervous laughs from associate
dentists, Wilson says, “We’d make jokes about them dressing up
as tooth fairies, but the dentists were not employed to treat the
children, they were there for adults. Whereas my special interests
are with the kids. Obviously children under the age of four have to
be treated by a dentist, but I’d take it from that age upwards.”
To enhance the fairy experience for young patients, Wilson had
the walls and furniture painted in soft colours. She’s gone a step
further in the Gold Coast surgery, setting up embellishments like
fairy lights in the ceiling. The process of a visit to the tooth fairy for
children involves being greeted by the fairy, and taken through the
fairy wonderland. As a result of her interaction with children and
parents, she decided to write a book incorporating some of the
tooth fairy phrases she found herself using over and over.
“The book came about because there’s nothing out there from
the tooth fairy’s perspective. The story follows a normal procedure, and it’s illustrated by a young local girl, and self-published.”
The book—The Story of the Toothfairy ... as it has never, EVER
been told—is coming out this month, and Wilson has lined up
sponsorship by a local radio station, as well as plans to promote
it through schools and of course her surgeries. “I’ve got a few
colleges booked in,” she says, “and I go to assembly in the character of the tooth fairy and I’ll read the story two a child at the
school. So I’ll get a child up on stage to read the story to them.”
She’s also found a deep well of support amongst her former
colleagues in the school dental service, which is a positive thing
for them at a time when school dental services are suffering
from ever-diminishing funds. “I know how hard it is for them,”
she says. “So we’re working in conjunction with them, and
they’re really great to refer patients to me. They do bogged
down, so we’re offering a back-up opportunity for parents who
want to come privately.” £
For more on the Tooth Fairy, go to www.tfidentistry.com.
It’s easy
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14 Bite
Bite.indd 1
29/07/2010 9:28:48 AM
16
Your world
Proﬁle
Article Sharon Aris
Photography Eamon Gallagher
Established for over three decades, the East Bentleigh Dental Group is a case study in
how to build up a large successful practice by staying true to your vision
Wild about Harry
his shopfront surgery of the East
Bentleigh Dental Group is the life
work of Harry Marget. Graduating
from dentistry at Adelaide University
in 1972, Marget says he realised
from day one, “I wasn’t going to
be a traditional dentist: one nurse,
drilling and fillings all day.” His
dreams were far bigger. He wanted
to create an empire. So shortly after
graduation he moved to Melbourne,
working in general practices in Camberwell and Hawthorn before shifting to a practice specialising in crowns and bridges in
Collins Street. But it wasn’t long before he set out on his own.
“I decided I wanted to find a practice that was just a bombedout shell—a dinosaur. I found this one in East Bentleigh. The
surgery was 40 years old. The toilet was outdoors, down rickety
stairs. The dentist never worse gloves. The equipment dated
from World War Two. I walked in and said ‘I heard you wanted
to sell you practice’. He said ‘I want $13,000, take it or leave it.’
“I said, ‘I’ll give you $10,000.’ He took it.”
Marget ran to a bank in the city and pleaded for the $10,000.
It was December 30th. Over the next fortnight Marget rebuilt the
surgery, ripped up the lino, painted and decorated. “I opened
10 January 1974 and have never looked back.”
Which was no mean feat. Although the practice was booked
out more than six months in advance when he bought it,
Marget soon found it was because a sizable proportion of the
patients—many of them the previous owner’s Catholic clientele—paid nothing. And the work was all surface fillings and
extractions. Still, he had faith in the area’s potential. With “cows
16 Bite
grazing in the backyard”, it also had lots of growing young
families. So he set about empire-building, one patient and one
course at a time.
From graduation, Marget embraced a philosophy of ongoing learning, travelling first to London then the US doing course
after course on orthodontics. “I spent 10 years travelling the
world, going to every major orthodontic conference in the
States. I started branching out—crown and bridge, Invisalign,
practice management—I spent two years teaching practice
management. I spent three months in Japan learning complex implants.” Then he moved on to marketing. Indeed, says
Marget, of all the training he’s undertaken, the one he’s enjoyed
the most is the Million Dollar Round Table, “where top insurance
salesmen from around the world teach you how to sell.”
By the end of his first year he had his first assistant dentist.
Then another, and another. “I worked out early on I wanted to
create a business, and give people the opportunity to diversity themselves.” Then he bought a practice in Ellwood and
started another one in the city from scratch—a retail store. “We
went from no patients to being booked out weeks ahead very
quickly.” Then he bought another practice. At one point he had
four practices built up. The empire had expanded. Then, save
East Bentleigh, he sold them all. Lesson learned.
“There wasn’t a lot of profit to be made running multiple
practices,” he says. “There are four lots of staff, rent, training,
and problems. In terms of profitability, there is no point in having
multiple practices. In one practice you can consolidate expenses and marketing.”
Back at East Bentleigh he went about realising his core aim,
which was practice that could treat all a patients dental needs.
“We are focussed on providing every service under the sun—
Bite 17
Proﬁle
Margets realised he wanted a single practice offering everything.
children’s, orthodontic, sleep, Invisalign, fresh breath—we’re a
one-stop-shop. We’re unique in that respect. I have 15 dentists
and 43 staff, so we’re like a mini hospital.” They also offer
integration with complementary medicines like hypnotherapy,
kinesiology, osteopathy and chiropractors. “With new patients I
do a complete oral examination and complete physical examination. I plant seeds: ‘Do you have problems in your back, or
neck problems, do you have trouble sleeping?’ It’s my shock
and awe technique. ‘How did you know my lower back was
sore?’ Then I introduce the concept of whole body medicine.”
But he’s a pragmatist too. East Bentleigh Dental Group is also
a Medicare Private and HBA preferential provider. “I’ve been accused of prostitution in getting in bed with the health funds, but
they market me and it costs me nothing, and I get 60 to 80 new
patients a week,” says Marget.
M
aking a large comprehensive service work
doesn’t happen without the right mix of
people and Marget puts considerable effort into finding the right dentists and staff.
“I’ve brought people in from overseas, from
the US, China, India, Canada.” The practice lists a total of 16
languages in all. His guiding staffing ethos, says Marget, is “be
a dream giver, not a dream taker. When people come and work
for me I say ‘let’s build the dream’ You build a comfort zone for
people. Give them the capacity to reach that dream. And you
have to be there to make sure that dream comes true.” It also
means supporting people when things go wrong. “If someone
breaks a tooth root, I hold their hand. If I have to take them
aside, I take them outside. I say ‘we all make errors of judgement. This is one. We’ll make the changes needed’. Never be
negative. Be inspiring, Always say ‘we’ll fix it’. I work very hard
on staff. We do training every day.” His reward is staff loyalty.
He adds you must lead by example. “We ask ‘how do we do
this better?’ We bring in new technology. We keep standards
high. Be a leader: take the slings and arrows and run up front.
Who remembers who gets the silver medal at the Olympics?
You remember gold.” It’s working. Marget put his numbers at
seven and a half to eight million annually.
Still if there is any one key, it comes down to Harry himself.
“Harry has got to be one of the most enthusiastic dentists I’ve
ever met,” says Mark Van Weelde, managing director, Invisalign
18 Bite
Australia. And one of the most persistent. When Invisalign first
launched in Australia in 2002 they weren’t targeting general
dentists. Harry however, had other ideas. “He muscled his way
in,” chuckles Van Weelde, adding now he’s one of the biggest
submitters in Australia. “And he’s given me a lot of input on how
to make Invisalign work for general dentists. He’s been doing
orthodontic work for many years and he was quite instramental
in saying ‘you need to develop this product more’. He ensures
we speak once a week whether I like it or not.”
“Harry’s always thinking laterally,” he adds. “He’s always
prepared to give things a go and he thinks outside the box. His
staff have Invisalign advertising on the back windscreen of their
cars. He always carries cards wherever he goes. If he receives
exceptional service—and I’ve been with him in a restaurant
when this happened—he offers the person a free dental consultation. He says they’ll be great advocates of his practice.”
His enthusiasm also led him David Penn, a fellow dentist and
CEO of Southern Cross Dental Laboratories. Initially meeting
through the exceptional practice group, an invitation-only assemblage of some of the most successful dental practices in
Australia, Marget is now a motivational speaker for Southern
Cross when they do training in Invisalign. “He’s very passionate
about what he does. He gets very emotional. His heart is very
much involved in everything he does,” says Penn. But, he adds,
“The integrity is there. He’s not selling you something you don’t
need. He’s got tremendous business acumen and marketing
skills. He’s always having a go at something. To have a hugely
“We’re unique in the respect that
I have 15 dentists and 43 staff, so
we’re like a mini hospital.”
Dr Harry Margets, East Bentleigh Dental Group
successful practice you need good people skills but a sound
clinician as well.”
This infectious mix of enthusiasm, wide-ranging clinical practice, humour and good old fashioned hustle is embued throughout his practice. An enthusiast for new and social media, on
the practice website, alongside the clinical information, there’s
blogs, youtube links , Facebook links for teenagers undergoing
orthodontic treatments, product reviews and video tours of the
surgery. In his chirpy introductory video, Marget enthuses ‘the
most fun I have is coming to work and enjoy being here with my
team...’ ‘It feels more like a family,’ says one of his staff on the
video. ‘Harry Marget doesn’t feel like a boss, he’s like our dad’.
‘It’s just great fun being here,’ says Marget to the camera.
Now Harry has bigger plans again. He wants to replicate his
model up and down the east coast. In his ‘lock and key’ model
he find a young dentist just out of dental school. “We find a
great location, look for young family areas, and we build a four
chair surgery, all under one roof. We show the young dentist
how to do the service mix in dentistry. We do the marketing and
website design. We bring them in here for six months training.
We train them in endo, Invisalign, orthodontics. We support
them all the way thought and gradually release them, but we
retain the freehold All they have to do is come in, wash up and
sit down. It’s working with us with the ultimate idea of owning.
The only thing they have to put up with is my jokes.” £
20
Your business
Design
Article Rob Johnson
Photography Simon Wood Photography
Underwater love
When patients see calming vision of ﬁsh rolling through coral during their surgery at
Macquarie Street’s Dental Lounge, it’s not the painkillers kicking in
ompeting with a view in Sydney is
pretty difficult. Competing with a
view of the city’s botanic gardens
is nigh impossible. But that’s what
Drs Mark Braund and Daniel Adamo of Dental Lounge wanted to
do—find something that competed
with their surgery’s million-dollar
view over Macquarie Street. They
discussed it with their architect,
Joshua Mulder of JM Architects, and came up with a somewhat surreal solution—fish.
“The suites in this building are all quite small, and there’s
16 in the whole building,” explains Daniel Adamo. “We’ve
got one that looks over the Botanical Gardens, and has
a beautiful view. Most of the rest of the suites are owned
by the College of Physicians, and they’ve owned for years
and years, and they rarely come up for sale. However,
recently the one out the back of ours became available, so
we bought it. Unlike our existing suites, the back one had
no view, so we had to come up with something that could
compete, something that made it special in and of itself.”
Problem was, they’d pretty much reached the limits of
their own design abilities with the front suite. “We did the
build of the front suite ourselves, but we couldn’t really
much it up because that view was so good, no matter what
we did it would always be fine,” says Adamo. They tossed
a few ideas around, then approached Joshua Mulder and
asked him to come up with a design that looked good and
accommodated three chairs and a steri room.
“Mark [Braund] came up with the aquarium idea, but only
as a suggestion, then Josh just ran with it,” says Adamo.
“Mark [Braund] came up with
the aquarium idea, but only as
a suggestion, then Josh just ran
with it.”
Dr Daniel Adamo of Dental Lounge
“His design was nothing like what we conceived.”
Mulder saw the request for an aquarium as an opportunity
to take things “to the max”.
“We came up with a concept that divided the main entry
from other treatment rooms by having a continuous aquarium wall running down the length of the practice, to maximise the experience,” he says.
But of course, nothing is ever that easy.
“The biggest challenge we needed to get our head
around was the issues you face when working with an older
building, and with predominantly concrete walls,” says
What can compete with a
view of the Botanical Gardens? Fish, of course.
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Q U A L I T Y
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22 Bite
The biggest factor affecting
the design was the weight of
the ﬁsh tanks, says Mulder.
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Mulder. Those old Deco buildings look wonderful, but aren’t
actually designed to be carrying around large aquariums.
“The biggest factor was the weight of the tanks,” he continues. “The structure had to take the weight, and the tanks
needed to be matched. So the challenge was to still get
that wow factor while being mindful of those constraints.
We initially thought of doing floor to ceiling tanks, but just
through the nature of the construction and the weight, we
were restricted to the strip through the centre. Together
with the natural space constraints—the suites are quite
small—the tank size had to be a certain thickness too,
which impacted on the size we had to work with.”
For every litre of water in the tanks, the weight would
be one kilogram, which made the combined weight of the
tanks more than a tonne. At that weight, the tanks had to
be supported on a subframe, which then presented the
challenge of levelling everything off accurately. “It’s a lot of
weight in a relatively small area,” says Mulder. That wasn’t
the only problem: The suites were five levels up. There
was only one lift you could bring things up in. So the tanks
couldn’t be manufactured off site and carried up—they had
to arrive in pieces that would fit in the lift, or be ale to be
carried up the stairs.
“When we originally spoke with the aquarium guys, we
asked them what’s the biggest tank we can get up in this
space?” Mulder recalls. “They said we can do two and a
half metres long by a metre high. At that point they were
thinking they could get it up in the lift. Then they tried it and
said no, we can’t. So they walked one piece of glass up
the stairs, and the others had to be cut down to be bought
up in the lift. The number of cuts were determined by the
fact that you couldn’t have too many joins in the glass or it
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he original floor presented the builders with
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Mulder explains. “We needed to raise the floor as well, using materials which were a bit more tactile and warm, which
almost gives the impression of a sandy beach. So it really
had a theme of the full experience of being in water.”
From the point of view of the owners, the whole experience was quite a pleasant one: business in the suites continued as normal for the course of the build, says Adamo,
and while he remembers things may have gone slightly
over-time and budget, it was all controlled by Mulder. And
the end result is quite spectacular.
“The aquarium is double-sided, so when you walk past, if
you looked really hard, you could see through the wall into
the treatment rooms,” Adamo says. “Of course, you don’t
have a clear vision to do that—there’s plenty of distractions
in the way, like plants and fish. We actually had the first day
of using it recently, and we’re planning an opening party for
some time this month. The people we’ve taken up there to
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wouldn’t be as aesthetically pleasing. So it was a challenge
getting the glass up there.”
Rather than one continuous aquarium, the solution Mulder created involved three aquariums set into a glass wall.
“The aquariums are set up at eye-level,” he explains, “so
you’re walking between each one into the treatment rooms.
Above and below is all glass, then it has a film of glass with
an image printed on that so it looks like a water wall.”
Bite 23
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25
Your business
Endodontincs vs implantology
The turn of the screw
When are implants the right decision? It’s a tricky question for any practitioner
to answer, and some experts think not everyone is qualiﬁed to answer it.
Article Andy Kollmorgen
Photography iStockphoto
he arrival of dental implants in the early
1970s was a hailed as a breakthrough.
And with good reason. Compared to
what was previously available—dentures, for instance—an implant was
much closer to the real thing. Most
experts say it still is.
But breakthroughs tend to be
dangerous when they fall into the
wrong hands. With something as
commercially viable as being able to permanently replace teeth,
everyone wants to add the service their repertoires—regardless
of whether they’re qualified to deliver it. These days there’s a
growing concern that dentists are going ahead with implants
when the original tooth could and should be saved. Is there
a profit motive behind the perceived trend, or do some practitioners honestly not know what they’re doing? It’s a question
that’s getting asked a lot lately.
A recent article in the Journal of Endodontics lays out how
hard the decision can be. “Not only is the choice of treatment
controversial, but even the criteria for defining a tooth as compromised are controversial and subject to interpretation.”
And in April last year the Journal of the American Dental
Association (JADA) weighed in on the issue, saying “clinicians
regularly are confronted with difficult choices”. In cases of
implants versus endodontics, however, the decision should not
be “guided solely by the desires and clinical experience of the
practitioner. It must be based on scientific evidence, and ideally
it should preserve the biological environment”.
Dr Figdor believes the sensible
way to maintain best practice
is to consult a specialist
before going forward. But he
understands some general
dentists may not be inclined to
do so.
Maybe it’s a matter of taking the time to figure out what’s
right. Melbourne-based endodontologist Dr David Figdor says
knowing when to write off a tooth or stick with the tried-andtrue approach of root canal and crown (or, when appropriate,
a bridge) is not necessarily a tall order. As long you know what
you’re doing—and you’ve got the patient’s interests firmly in
mind. “Where the controversy has come about is that some
Bite 25
Endodontincs vs implantology
people are really pushing the envelope. Some would say there
are strong commercial pressures; that dentists could be better
informed about the possibilities of saving the tooth.”
Dr Figdor believes the sensible way to maintain best practice
is to consult a specialist before going forward. But he understands some general dentists may not be inclined to do so.
He says an implant is the right choice only when the tooth is
“essentially unsaveable” and the endodontist is ideally placed to
help make that decision. His concerns centre on “overzealous
application of extraction followed by implants”.
For specialists like Dr Figdor, a historical view offers muchneeded perspective. He points out that endodontic treatment
“has been around for a long time and the success rate is relatively high”. The same cannot be said for implants.
The latest comparative study (also published in the Journal of
Endodontics ) says 129 implants required follow-up treatment
after an average of 36 months and showed a “success rate”
of 87 per cent, while 143 endodontically treated teeth were
still in good shape after an average of 22 months and were 90
per cent successful. “We found that 12.4 per cent of implants
required interventions, whereas 1.3 per cent of endodontically
treated teeth required interventions, which was statistically
significant.” However, the study makes clear that the need for
follow-up treatment did not indicate failure of the procedure.
“The success of implant and endodontically treated teeth was
essentially identical, but implants required more postoperative
treatments to maintain them”.
D
r Figdor says the postoperative question is critical, as is the definition of “success”. “If you look
at outcome studies for implants, they generally
report very high survival rates. I don’t think that’s
accurately presenting the full picture. It depends
on how many years you follow up and how technical and biological problems are reported. Over time, a significant proportion of patients will experience complications with implants.
They can run from minor maintenance to more serious complications like bone loss or peri-implantitis.”
Dr Barry L. Musikant, who says his practice’s mission is
“rational” endodontic techniques and restoration of endodontically treated teeth, maintains there’s room for discretion but
adds that skilled dentists know when to make the right choice.
His practice is located just off New York City’s Central Park, but
he has lectured internationally and written extensively on the
subject. He says the issue is of universal concern for dentists as
well as patients.
“I believe that in some cases the choices are obvious. If a
tooth is pretty much intact, there is no question that the root
canal should be done, provided that the dentist or endodontist
has the skills required to do what is considered a good job. If
a tooth is so thoroughly broken down that saving it would take
heroic efforts and result in only a guarded prognosis, there is
no question that an implant should be considered if the bone
is present to accept it and the health of the patient does not
contraindicate it. So what we are really talking about is the gray
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2003 First to market with a choice of SQL database engines
2004 First to release telephony integration and barcode scanning as part of
a practice management suite
2005 First to release fully integrated Presentation Manager
2006 First to release SMS appointment reminder capability within the system appointment book
2007 First to release digital integration embedded into Practice Management Software
2009 1800 Practices installed in ANZ
2009 First with multi branch, flexible commissioning function
2010 First Dental Practice Management Software to be HICAPS Connect Certified.
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26 Bite
The case for implants is based on many factors.
area, where dentists may differ in opinion on what should be
placed.” JADA gets more specific, saying people with poorly
controlled diabetes, compromised immune systems or those
who smoke are probably not good candidates for an implant.
The organisation—which has made implants versus endodontonics a frontline issue over the past couple of years—also
points a finger at potential conflicts of interest. “Treatment
planning usually is affected by the views of the stakeholders
[patients, insurance companies and dentists], who have varying
perspectives and expectations regarding the outcome of treatment. Treatment should be patient-centered, not be based only
on dental insurance benefits and not be guided solely by the
desires and clinical experience of the practitioner.”
It also says people with chronic caries or periodontal disease
problems or those who have “a limited ability to perform routine
oral hygiene procedures” should probably not get an implant.
EW
N
Then who should? Ultimately, the decision hinges on practitioners’ skill and objectivity in assessing the patient—and on
their knowledge of where implants should go and how to keep
them healthy. The Australian Dental Association, for instance,
says implants have a 98 per cent success rate in the lower
jaw, but “the further back in the mouth you go, the lesser the
prognosis—sufficient bone to accept the implant is the major
limiting factor”.
According to a report by the Cochrane Oral Health Group
(which describes itself as an “international organisation that
aims to help people make well-informed decisions about healthcare”) published in the Australian Dental Journal, the build-up of
bacteria beneath implants is the major cause of failure.
“One of the key factors for the long-term success of oral
implants is the maintenance of healthy tissues around them.
Bacterial plaque accumulation induces inflammatory changes
in the soft tissues surrounding oral implants and it may lead
to their progressive destruction [perimplantitis] and ultimately
to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which
are the most effective.”
The report concludes there is no measureable advantage of
antibiotics over “deep mechanical cleaning” to prevent implant
failure. The lack of clear guidelines is in keeping with the issue as a whole. While some dentists may be recommending
implants without due diligence, whether or not they have done
right by their patients is rarely a clear-cut case. £
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Bite 27
28
Your business
Human resources
Article Rob Johnson
Photography Stockxpert
Beating the bullies
Workplace bullying is an issue receiving increasing attention in recent
years, and it happens more frequently than you may think.
t’s a truth universally acknowledged that dentistry is a caring profession, and so the problem of workplace bullying
would not be an issue for those in the profession. Indeed,
when Bite contacted one dental consultancy to discuss
the issue, we were told they couldn’t make a comment
because they didn’t think it happened in dentistry at all.
But despite the absence of local data about dental
workplace bullying, a recent New Zealand study suggests
that it may be much more common than you’d think. In
fact, the study—published last year in the journal Occupational Medicine, and written by Ayers, Thomson, Newton,
Morgaine and Rich—surveyed Kiwi dentists and found “workplace bullying was reported by one-ﬁfth, and over one-quarter
had experienced a violent or abusive incident”.
Erica King, owner of DCA Dental, goes further: she says
workplace bullying is rife. “And the bullies are young female
dentists,” she adds. “I’ve got eight practices, and we have a
high proportion of young female dentists, and they have support staff who are all female. So you have dentists who are
ﬁnding their feet, and are not always sure how to work with
others, and not sure of the difference between being assertive
and being aggressive.
“The most common scenario is where a dentist becomes
aggressive towards staff. In the last year I could cite several
instances where a dentists has yelled at staff and thrown things.
I take it very seriously, because I have to.”
Although people have been talking about workplace bullying
for over a decade, it really wasn’t until the death in 2006 of 19year-old Victorian waitress Brodie Panlock—who was bullied so
relentlessly by four of her colleagues that she ended up committing suicide—that the general public, and legislators, seemed
28 Bite
to realise the serious consequences of bullying. The tragedy
was compounded by injustice when, following a prosecution by
WorkSafe Victoria, those responsible were let off with ﬁnes.
However, following a coroners inquest, the Victorian Government announced 40,000 workplace inspections for bullying. That
in itself promised to counter one of the greatest hurdles to tackling the problem—the victims’ unwillingness to tell others. Most
commentators agree the problem is massively under-reported.
“My strategy is to approach
the problem head-on. I go to
the dentist directly about the
problem. Sometimes that works,
sometimes it’s a disaster. I then
give staff coping mechanisms, to
not react in a negative way and
to create an environment that
doesn’t support bullying.”
Erica King, DCA Dental
According to a newspaper report last year, while the Productivity Commission says more than 2.5 million Australians have
been bullied in the workplace, it’s thought that less than a third
ever complain about the bullying. The paper said one reason
is that one psychological effect of bullying is a strong sense of
hopelessness and disempowerment. Another is simple pragmatism; people want to protect their careers.
The New Zealand study cited earlier found violence and ag-
IF this is how you look to your staff, you may have a problem.
gression towards dental personnel was on the increase, even if
it remains less common than in other health care workplaces.
There is also wide variations in the numbers cited in various
studies. “The prevalence of workplace bullying is also concerning, especially as it was associated with sick days taken and it
appeared to be a particular concern for female and employee
dentists and those aged between 40 and 49,” the authors
wrote. “Further investigation of workplace bullying and aggression would be useful.”
E
rica King doesn’t believe it’s a new problem, but
she says, “Right now, I’m ﬁnding it’s at a critical
point as an employer. It creates a negative working
environment.” She says in her experience most
problems stem from the mood of the dentist.
“Dentists are moody professionals working in a stressful environment,” she explains.
“Any dental team is there to support the dentist. So the
mood that the dentist is in completely dictates the way the staff
behave. If the dentists arrive in a bad mood, the staff are in for
a bad day. I’ve had staff who get physically unwell hearing the
dentist coming in the front door.”
She says anyone who believes bullying doesn’t happen in
dentistry is in denial. “It’s a business, and you’re dealing with
demanding patients and staff,” she says. Society has changed
since then, and sometimes those changes increase the stress in
a workplace. For example, she says, “When I started 20 years
ago, assistants were in a service role, but now you’ve got these
dynamics where young ladies are much more opinionated, more
educated, and want to contribute more to the team—and that
sometimes causes conﬂict. Another source of stress is patients
with access to the Internet who are much more savvy, and
nowadays they question everything. The frequency of litigation’s
up—the medical profession was always having problems with
litigation, where dentistry now faces more than every before.
But there’s also dental-speciﬁc problems, such as the introduction of the Medicare EPC scheme, which has created major
stress for dentists because patients come in thinking they can
get this free dental work done after a lifetime of neglect. Trying
to get them to understand that it doesn’t work like that creates
problems and that’s increased stress levels.”
But the big question is, what to do about it? On a macro
level, only two states in Australia have speciﬁc legislation on
workplace bullying. Those two states, Queensland and Western
Australia, have had a signiﬁcant decline in worker compensation
claims related to bullying since the introduction of bullying speciﬁc codes of practice. Queensland has reduced the number of
bullying claims from 265 to 130 over ﬁve years, while Western
Australia had just 20 claims in 2008.
Some people believe the quickest and easiest way for a staff
member to deal with bullying is to leave the job, but Erica King
tries to counter that—good staff are too hard to ﬁnd, she says.
“My strategy is to approach the problem head-on. I go to
the dentist directly about the problem. Sometimes that works,
sometimes it’s a disaster. I then give staff coping mechanisms,
to not react in a negative way and to create an environment that
doesn’t support bullying.
“We won’t tolerate it, same as we won’t tolerate discrimination. Sometimes I do lose staff and dentists over it. But its an
ongoing thing with personalities, and can only be addressed
when trying to balance egos, the demands of staff, and the
demands of patients.” £
Bite 29
30
Your business
People management
Article John Burﬁtt
Photography Stockxpert
Good reviews
If Performance Evaluation sessions are the time of year that everyone dreads,
then it may be time to reconsider the way you are doing business.
here’s little chance that performance
evaluations will ever win any workplace popularity contests. When it
comes to days on the annual calendar
that the staff looks forward to—like the
Christmas party or announcements of
pay rises and bonuses—the performance evaluation is usually found at
the other end of the scale as a red
letter day that is dreaded.
Performance evaluations suffer from an image problem, so
much so that many—employers and employees—will go to any
lengths to avoid them. Rather than being seen as a valuable
opportunity for open communication within an organisation
and for the setting of new work goals, most staff seem to fear
them—on both sides of the meeting table.
“I have been coaching hundreds of dentists for five years
around Australia and New Zealand, and have noticed a trap that
dentists fall into is a fear of confrontation,” says Dr Joanna Gray,
a trainer with Momentum Management.
“We do training sessions with as many as 20 dentists in
the group. When I ask who is has a fear of confrontation at
work, 80 to 100 per cent of the room will say ‘yes’. It is a big
issue for them.
“But the problem in not saying anything is that the dentist
then does not get what they need, and then the staff gets no
direction, which can lead to general discontent, which does not
help anyone.”
The fear, however, can be attributed to a lack of confidence
in how to actually conduct an effective performance evaluation
and some of the finer details of staff management.
30 Bite
Gray recalls one dentist who was fearful of reminding an
employee that the practice floor needed to be mopped regularly, which was part of the job description, but never told her.
Eventually, it became a problem.
“I also have many staff members saying how much they like
their boss, but all they really want from them is to be told what
they want in the job,” Gray adds. “So when confrontations do
happen, they can happen very badly.”
Bernadette Beach of Indigo Dental Consulting says the problem in managing staff stems back to the initial training a dentist
undertakes for their career.
“The problem in not saying
anything is that the dentist does
not get what they need, and then
the staff gets no direction, which
can lead to general discontent,
which does not help anyone.”
Dr Joanna Gray, Momentum Management
“Dentists attended university to learn how to care for patients,
not how to manage a business,” says Beach.
“This is why it is an on-going learning curve for them as they
learn how to manage staff and get the best out of them. That
process can be quite overwhelming and if you don’t do it well
you can have a de-motivated staff and an environment where
everyone is walking on eggshells.”
With perception the obvious problem, the concept of the
performance evaluation needs a makeover. For evaluations to
If you donâ&#x20AC;&#x2122;t give her regular
performance evaluations, she
wonâ&#x20AC;&#x2122;r be as effective as an
assistant
Bite 31
Your business People management
Without direction,staff suffer higher stress levels.
be effective, they need to be seen as a regular and constructive
process of the business, and that change needs to start at the
beginning—of each staff member’s employment, as well as with
the way each evaluation is conducted.
“It needs to become a part of the way your business operates,” says Beach. “After three month’s employment, it is
essential to do the first review, and then to possibly do it again
after six, nine and definitely at 12 months.
“What that does is give the employee goals for every three
months that will complement the goals of the practice, and then
at the review you can both look at what was achieved and how
it worked. It is to identify problems earlier on than later when
they have escalated.
“Very often, as a result of not
having set it up properly in
the ﬁrst place, it can become a
difﬁcult conversation.”
Dr Phillip Palmer, Prime Practice
“This is something that must be scheduled in as you would
schedule any other important meeting. It will also make being
reviewed just part of the process for both the employee and
the employer.”
A comprehensive job description is the essential foundation
stone guide for all employees of what their role entails. “And
you would be amazed how many practices don’t have job
descriptions,” adds Beach.
How that staff member performs in relation to those
outlined responsibilities should be the basis for the
performance evaluation.
One recommendation is that in advance of an evaluation,
managers should present two items of paperwork to their staff.
One is for each staff members to outline and rate their own
performance, and the other provides an agenda of the items
32 Bite
to be discussed during the meeting. “That lets the team have
a think about what they have been doing, how they have been
doing it and where they want to go from here—and that is really
valuable for them,” says Beach.
“It also lets them feel this will be a 50-50 meeting, with the
discussion going both ways.”
An established agenda also assures the evaluation meeting
will stay on track and cover the areas that need be discussed.
If you don’t do it with written forms in front of you, then you are
making it up as you go, says Dr Phillip Palmer of dental management consultancy Prime Practice.
“Make sure you have a list of topics, rather than pulling
things out of the air,” he says. “Very often, as a result of not
having set it up properly in the first place, it can become a
difficult conversation.
“Telling someone that you are going to review them can
almost sound like, ‘I am about to chastise you’. On the other
hand, if it is properly setup as an expectation of a procedure
that comes with the job then it can be an anticipation of something beneficial and a constructive review that most employees
will look forward to as part of their career development.”
he evaluation should also be the annual focal point of all the feedback and direction
that has been given from the dental employer to the staff. It is not, insists Palmer,
the time to unleash issues that have been
festering away for months.
“There should be no surprises in a performance review,” says
Palmer. “There should have been feedback given during the
course of the year as to how someone is going. The team
member should know if they are doing the right thing throughout the year, rather than waiting to be told in one big meeting. If
however, that is how the practice is being run, then it is time to
review your management methods as well.”
As is the case with any staff meeting, attention also needs to
be paid to keeping the meeting focused on what the intended
outcomes of the evaluation will be.
“Normally, the desired result will be some kind of action
plan of how that employee can continue to do what they do
well, and improve in the areas they need to improve on,”
adds Dr Gray.
“There must be a clear plan with specific action they can
take. So if they are told they need to improve their communication skills, how they go about that and how that will be
measured is clear, with a timeline set and a follow-up date
agreed on.”
Dr Palmer adds that both sides of the meeting should emerge
feeling they have achieved something productive for both their
futures within the workplace.
“It has got to be constructive and helping with that person’s
career and personal development as well as the running of
the practice,” he says. “It is not relevant whether the review
is for an employee dentist, a team member or the front desk
person, it doesn’t matter—it needs to be clear.
“A performance review shouldn’t be something that causes
distress. It should almost be celebratory, with some sort of recognition for a staff member about their good work as much as it
is critical for when the work needs to improve.” £
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24
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35
Your tools
Reviews
A great intraoral camera, an excellent intraligamentary syringe, and a good pair of ears
and more are all on show this month
Tools of the trade
EccoVision
Listening
by Dr Sandie
Earl, S H
Earl Dental,
Rockhampton,
QLD
by Dr Glen Hughes,
Alstonville, NSW
EccoVision is a
computerised
system for helping
people with dental
sleep disorders. It
takes volumetric
measurements of
the airway and creates a graphic and numeric reading.
From these readings, I am able to design a unique appliance for
each patient.
I receive many referrals from the ear, nose and throat (ENT)
specialists in the area enabling the use of this machine on a
daily basis.
What’s good about it
The readings are very accurate. There’s a small tube to
measure each nasal airway (rhinometry) and a mouthpiece to
measure the oral airway (pharyngometry). We take two different
measurements. Firstly, a daytime (awake) measurement where
the subject just passively breathes in and out. Then to mimic a
night time (asleep) measurement, the patient takes a breath in
and fully releases it slowly to mimic the collapsed, relaxed airway
when we sleep. The graphic read-out gives patients a clear visual
picture of their situation. They often have difficulty interpreting an
x-ray but usually understand the EccoVision graphic.
Whereas a lot of snoring centres rely on a one-size-fits-all
appliance, I use the reading to trial various jaw positions for
maximum airway. Then I have an appliance manufactured to
individually fit each patient. In some cases, it even shows that
nothing I can do will assist them.
Once a patient is comfortable with the appliance, I take
another set of readings to confirm the improvement. Referrals
from the ENT specialists have a sleep study done with their
appliance fitted. The patient response has been very positive.
As a dentist who has worked
for many years in developing
countries, I am amazed that
we rarely use simple senses
to diagnose. It’s almost like
we can’t see without loupes,
we can’t feel without a probe,
we can’t smell without a
culture and we can’t hear
without some form of digital amplification. Listening is a very
valuable tool in dentistry.
What’s so good about it
In the field of restorative dentistry, the sound of tooth against
tooth is very different to tooth against any restorative material. I
find I can ‘hear’ a correct bite with a higher degree of tolerance
than can be detected with the finest articulating papers. I always
listen to the occlusion after polishing fillings and often make
additional adjustments even after an articulating paper record
tells me the bite is clear. My return rate for occlusal adjustment
has greatly improved since I started listening carefully.
In endodontics, the sound of a tapped tooth that is vital is
different to that of a tooth that has periapical inflammation.
Instead of a ring, the sound is dull and muffled wherever pus
is present. Even though I still confirm the diagnosis with pulp
testing and radiographs, I have often picked up a ‘feeling’ about
an asymptomatic, chronically abscessed tooth simply because it
sounds different to the other teeth.
Listening carefully helps to identify which tooth is different.
This can be invaluable in some mouths where multiple amounts
of complex dentistry make it difficult to choose between two or
three teeth that all have a similar radiographic appearance.
I would encourage other dentists to add technology to their
own armamentarium, but never let it replace the senses we have.
It would be a sad day in dentistry if we choose complexity over
simplicity, or prefer the expensive over what is free. Cheap and
simple are not always the enemy of good outcomes. Sometimes
I have found that less is more!
What’s not so good
It uses an old DOS system that really needs an upgrade or a
software update.
What’s not so good
There are no negatives.
Where did you get it
Body Logic .£
Where do you get it
It comes for free though it needs to be honed with use. £
Bite 35
Your tools Reviews
Intraligamentary syringe by Medesy
by Dr Mark Schwartz, Waratah Dental Centre, Engadine, NSW
This gun-shaped syringe forces anesthetic under pressure down
the sides of any tooth you choose to numb. Its effect is extremely
local and only provides numbness for that particular tooth. I’ve
been using it since it first came onto the market in the mid-’80s
and there is rarely a day when I don’t use it at least twice.
Elca Intraoral Camera
by Dr Ralph Kelsey, Sure Dental, Wavell Heights, QLD
I use this intraoral camera to display a moving image as I take it
for a tour around the mouth. It is attached to a foot control so I
can freeze the image at any point and store it in the patient file.
The images are displayed on a monitor that patients can see
when they are reclined in the chair.
What’s good about it
I wouldn’t set up a surgery without an intraoral camera. It is
excellent for patient education, confirmation of clinical signs, and
for clinical records. I chose this camera because it’s compatible
with the Adec equipment I use. It’s ideal to have the intraoral
camera software interfacing with your system software. That
way, when you record an image, it’s automatically saved onto the
patient file.
Patients love it and often comment that they have never
seen inside their mouth before. When trying to explain treatment
options, it can be difficult for patients to visualise what you
are saying. However, once they see an image, they understand
immediately, which helps greatly with the acceptance of
treatment proposals. Patients love to see the finished result
after work is complete—the before-and-after shots have a
great impact.
I have three hygienists working with me and I have a camera
set up in each room. Showing patients what is happening inside
their mouth helps them understand the importance of their visit.
The after shot then reinforces the benefits of being here.
What’s not so good
They are a little expensive to purchase but, as far as I’m
concerned, the return on investment far outweighs that negative.
Repairs can also be expensive, though that has only occurred
twice in four years.
Where did you get it
Supplied by Independent Dental (Brisbane Birkdale) and installed
by Ross Jones Dental 07 3391 0208. £
36 Bite
What’s good about it
In many situations, it’s an effective substitute for block injections.
It works virtually immediately and doesn’t cause unnecessary soft
tissue numbness.
It’s also an invaluable tool for differential diagnosis. A
patient with a difficult-to-isolate symptomatic tooth can have
teeth sequentially anaesthetised in order to determine the
source of pain.
It provides ample anaesthesia for routine restorative
procedures. Patients occasionally appreciate not having that
numb feeling when they walk out. It’s also a valuable ancillary
injection when dealing with ‘hot pulps’ resistant to traditional
LA administration.
When using the technique for infiltration, especially in the upper
anterior area, the enforced slowness of fluid expulsion means a
far less traumatic injection for the patient.
Phobic patients are sometimes less stressed as they do not
associate the alien shape entering their mouth to a ‘needle’.
What’s not so good
It is technique sensitive, so a fair degree of patience is needed
to obtain consistently successful results. It can’t be used at sites
affected with periodontal pocketing greater than 5mm. And there
is an inherent failure rate. The anaesthetic appears to fail in about
three-to-five per cent of patients.
Interestingly, though, auxiliary anaesthetic to provide a
perceptible numbness without clinical action often ‘magically’
remedies the ‘failure’, again demonstrating the close association
between cognition and reaction.
Where do you get it.
Ridley Dental Supplies, Peakhurst, NSW. £
������������������������
4 mm in a
single cast.
•
•
•
•
Increments up to 4 mm without layering
Excellent flow-like cavity adaptation1
Compatible with your current adhesive2
Up to 60% less polymerization stress3
www.dentaladviso
r.com
Editors’ Choice
+++++
�����������������������������������������������������������������������
���������������������������������������������������������������������������������������������
1
2
3
In comparison to posterior and universal composites.
Chemically compatible with methacrylate based adhesives and composites only.
Compared to conventional light-cured Polymerization.
38
Your life
Passions
Dr Julian Leigh Half Moon Dental Centre, Minyama, QLD
,
“I’m a ﬁreﬁghter for the
Queensland Fire and Rescue
Service. Living in Maleny,
which is about 40km from my surgery, I
work in a stand-alone auxiliary station.
There are 10 of us and we’re on call
24/7, 365 days a year. Our nearest ﬁre
station for back-up is about 35 minutes
away. Once our pager goes off, the
truck has to be rolling within seven
minutes, although we normally get our
truck rolling in under four minutes.
“We’re a frontline Fire and Rescue
unit. Last ﬁnancial year we had over
100 calls, which means one every three
days. Most of these are vehicle accidents and we sometimes have to cut
people out of cars. We don’t get called
to bushﬁres unless it’s threatening a
structure. It’s not only the fulﬁlment of
a kid’s dream
We do the
being a ﬁreman
same training but it’s great to
be part of the
as full-time
local commuﬁreﬁghters
nity. We do the
same training as full-time ﬁreﬁghters,
covering an area that contains about
15,000 people.
“A majority of ‘000’ calls are at night
or on the weekend which means I miss
few ﬁre calls while at work. A few times,
we’ve had some big jobs where I’ve
had to re-arrange my patient appointments. These are usually house ﬁres or
fatalities in the small morning hours.
“We had one incident where we had
to go into a burning house as there was
a child trapped inside. The crew managed to get inside safely and rescue the
child and then save the house. Sometimes after you’ve done something like
that, you sit back and think, ‘That was a
bit hairy’. But our training—which is excellent—just kicks in. Being a ﬁreﬁghter
has been stimulating both mentally and
physically. Mind you, when the pager
goes off at 3am and you have to cut
someone out of a car then
rush to work and take out a
wisdom tooth at 9am, it can
make for a very long day!
38 Bite
TM
twice-daily brushing
60 %
70%
improvement
2
Sensitivity relief
Air blast sensitivity score
3
1
0
Baseline
Immediate
When applied directly
to the sensitive tooth
with a ﬁngertip and
massaged for 1
minute, Colgate®
Sensitive Pro-Relief™
Toothpaste provides
instant sensitivity
relief compared to the
positive and negative
controls. The relief was
maintained after 3 days
of twice-daily brushing.
3-day
Colgate Sensitive Pro-Relief™ Toothpaste
®
Positive control:
Toothpaste with 2 % potassium ion
YOUR PARTNER IN ORAL HEALTH
Negative control:
Toothpaste with
1450 ppm
ﬂuoride only
THE DANISH LOVE CLEAN DRY AIR.
Jun-Air oil-less compressors deliver hygienic, super-dry air quietly, reliably and economically.
Made in Denmark and now available in Australia. The best air is Jun-Air.
For your local distributor contact West Coast Dental Depot on (08) 9479 3244, fax (08) 9479 3255 or email air@westcoastdental.com.au
Made in Denmark